Abstract: The transition from undergraduate medical education to graduate medical education (GME) involves a process rooted in the final year of medical school. Students file applications through the Electronic Residency Application Service platform, interview with residency training (i.e., GME) programs from which they have received invitations, and generate a rank-ordered preference list. The National Resident Matching Program reconciles applicant and program rank lists with an eye towards matching students and GME programs. This process has effectively served generations of graduating medical students. However, the past several decades have seen an intensification of the residency placement process that is exemplified by an inexorable increase in the number of applications filed and number of interviews accepted and attended by each student. The authors contend that this trend has untoward effects on both applicants and departments that are home to GME programs....

"... in 2015, senior U.S. medical students applied, on average, to 73 of the 163 orthopedic surgery programs and 47 of the 105 neurological surgery programs (based on data extracted from the AAMC 8 and the NRMP 9,10). What is more surprising is that even less competitive disciplines may now be seeing an ever-growing flood of applications. This contention is supported in part by recent observations according to which GME programs in nearly all disciplines have seen a marked increase in their application traffic. For example, the percentage of pediatric GME programs to which graduating U.S. medical students have applied on average increased from 9.8% to 13.7% during the five-year interval from 2010 to 2015.10 For internal medicine GME programs, the corresponding figures are 4.9% to 6.0%.8–10 In making these decisions, students appear to be keeping their own counsel against the advice of medical school advisers and mentors advocating moderation.

...

"The increasing number of applications has another important consequence for GME programs. With an expanding burden of reviewing applications, the use of quantitative metrics as “screens,” the United States Medical Licensing Examination (USMLE) Step 1 exam in particular, may assume an increasing role. This trend, one that is viewed by many as a serious problem,15 may further erode emphasis on students’ backgrounds and qualitative indicators of performance, including letters of recommendation and narrative performance evaluations. Should this occur, it could have a detrimental effect on the ability of GME programs to achieve diversity by reducing the selection of students from disadvantaged educational backgrounds who may be at risk for underperformance on standardized examinations.

Apart from the preceding considerations, the growing intensity of the residency placement process has been progressively eroding the residual educational value of the fourth and final year of medical school.16–19 This reality, in its own right, would appear to warrant a reevaluation of the extant residency placement construct. Such reassessment may prove all but inescapable before too long if and when the four-year medical school curriculum is ever replaced with a three-year counterpart.20,21 Under these circumstances, the current resident selection paradigm is likely to prove unworkable and in need of redesign.

Sunday, July 30, 2017

Helping Boomers Find Millennial Roommates
LINDA POON JUL 1, 2017
In a college town, students and older homeowners have a lot to offer each other. That’s why two urban planners built an app to bring them together.
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Here's the app: Nesterly.
"On any given night, more than 50 million bedrooms sit empty across the U.S. Many of these spare rooms belong to older homeowners whose large houses have become a burden as they age. At the same time, millions of young renters struggle to afford the high prices in areas near schools and jobs. nesterly targets both of these issues by connecting older people with extra rooms to those seeking affordable rents through unique task-housing arrangements. Renters can now pay part of their rent by helping around the house, and owners gain stability, security, and support to stay in their homes."

Saturday, July 29, 2017

"Some 4,500 Venezuelan prostitutes are thought to be working in Colombia; the trade is legal in both countries. But until recently they were often rounded up by police and deported back to Venezuela by the busload. That changed in April, when Colombia's constitutional court ruled that Venezuelan sex workers are entitled to work visas. Mass deportations violate international human-rights law, it said. "One should weigh up the reasons they decided to come to Colombia...and the specific situation they would face in Venezuela were they to be returned," said the ruling.

The case has its origins in Chinacota, a tiny town an hour's drive from the border city of Cucuta. Last year the town's mayor closed down the Taberna Barlovento, a bar that also serves as a brothel, saying it violated zoning rules. Along with beverages, the bar offers four bedrooms just big enough to fit a mattress or two. Founded in 1935, the bar is a Chinacota institution, says Nelcy Esperanza Delgado, its owner.

When the mayor shut Ms Delgado down, she fought back in court. She and the prostitutes who worked there, including four Venezuelans, had no other income, she said. Closing Taberna Barlovento violated their right to work. The court agreed, and the bar reopened.
...
"Colombians along the border are accustomed to Venezuelans streaming across, but the area's sex workers do not relish the competition. Venezuelans charge the equivalent of $10-13 for a 20-minute session; the Colombian rate is around $13-17. Colombians complain that they are being forced to cut their prices. While Colombia is El Dorado compared with Venezuela, economic growth is slow and the unemployment rate is 9.4%. Colombians haven't forgotten that in 2015 Venezuela's president, Nicolas Maduro, blamed them for the shortages and deported 1,100. Many forded rivers on their way back to Colombia.

While the law is becoming more welcoming to desperate Venezuelans, Colombians are growing increasingly nervous about the influx. Barbara thinks other countries offer bigger opportunities. She is planning to move on to Ecuador, where customers pay in American dollars."

Wednesday, July 26, 2017

Explaining economics is something economists should do more of (especially in light of some of the silly things written about economics in the popular press by people who misunderstand what they are writing about). Here's a good example of good explanation, written clearly, by an expert:

Sally Satel on Organ Donation

Sally Satel, psychiatrist and resident scholar at the American Enterprise Institute, talks with EconTalk host Russ Roberts about the challenges of increasing the supply of donated organs for transplantation and ways that public policy might increase the supply. Satel, who has received two kidney donations, suggests a federal tax credit as a way to increase the supply of organs while saving the federal government money. She also discusses the ethical issues surrounding various forms of compensation for organ donors.

Highlights

Time

Podcast Episode Highlights

HIDE HIGHLIGHTS

0:33

Intro. [Recording date: July 6, 2017.]

Russ Roberts: Sally Satel recently wrote an article with Alan Viard entitled "The Kindest (Tax) Cut: A Federal Tax Credit for Organ Donations," and that's going to be our topic for today.... So, you bring a special perspective to kidney donations. Talk about your personal story.

Sally Satel: Yeah. I got a kidney in 2006; and then I got another kidney a year ago, almost a year ago today. And, when I got my first one it was sort of a surprise. A lot of people who know that they're going to need a kidney--well, by definition, they know that they're going to need a kidney. What I meant is that they have certain illnesses--they are either diabetic, or they've got lupus, severe hypertension that's been poorly managed for a while, high blood pressure. People know they are at risk for this, for kidney failure. But my case was sort of a surprise. I just went to the doctor for a regular checkup. This is the part of the story that scares everyone, because I felt completely fine. And during a routine blood draw, found out that I had--well, that I had kidney failure. Which is rather easy to diagnose. It's a test called a creatinine level. But when you go for a regular blood draw, a routine blood draw, that's one of the indexes they measure. So, they tested it again, and that was the same. So, the clock was ticking for me, because I knew from my medical training that if you have kidney failure, you need a new kidney, or you will languish on dialysis for years. And no matter how long you are on dialysis, your life will be prematurely shortened. I mean, people have lived for 20 years, even a little longer, on dialysis. Some people tolerate it better than others. That's a process where your blood is cleansed of toxins about 3 times a week for about 4 hours at a time; you go to a clinic. Most people feel very debilitated by it. The average person on dialysis can't hold a job. But some do. And, some people--it isn't as psychologically devastating to some folks. But others find it so distressing, they are actually--suicide is not that unusual. So, the idea of being tethered to that machine, while, granted, it would keep me alive. Now, if my liver had failed and I didn't get a transplant, that would be it. So, kidney dialysis does keep people alive for awhile. But it just seemed like a really, really half a life. So, I knew I needed a kidney, but I didn't know exactly when I would need dialysis. So, as I said, the clock started ticking. And it turned out I had a good year before the function got to the point where I really was becoming physically debilitated. But it was very hard finding a donor. And that's what kind of galvanized me, this whole issue of the shortage. But, just in terms of finding a donor, as I say, it was extremely difficult. It's not like every day you ask people for a body part. And I didn't have--I have a very tiny family. And, to make a long story short, none of them--I didn't feel I could ask any of them. And in fact I never really asked anyone. I would do it all differently if, heaven forbid, there is yet a third time I have to go through this--see, I'm very nice to my interns. But I would just talk about it with folks and wasn't even being coy. I just sort of thought magically, 'Oh, well some people will think of being a donor, and it will work out.' But it became pretty clear that it wasn't working out. And a lot of people actually said they would do it; and I appreciate that in that I know they wanted to be--I know they felt empathy for my situation; but in the end, basically, a lot of them got cold feet and backed out. And then you're in this terribly awkward position, because you really can't be angry. I mean it's an enormous thing to ask, and it would be incredibly presumptuous to have the expectation that they owed you anything. So, I was really getting very demoralized and about to get ready to go on dialysis. And, Virginia Postrel, who I knew, not very well, had been at a cocktail reception somewhere--this was in November of 2005--and she ran into a mutual friend and asked that friend how I was. And the friend said, 'Not so hot. She needs a kidney.' And, Virginia went--I think the next went to her computer--I remember the subject line; I still have a printout of her email--it said, 'Serious Offer.' And she said, 'So-and-so told me you needed a kidney, and if I match, I will do it.' And I think she followed up a few minutes later with another email: 'I won't back out.' And, so, she went through with it. This was March of 2006. And I'm almost as grateful to Steve, her husband, as to her, because that was one of the reasons that two of my friends, other of my friends who had seriously considered donating did not go through with it--because their spouse basically said, 'It's the kidney or a divorce.' [More to come. 6:48]

Monday, July 24, 2017

"The aim of this conference - organized on the occasion of Kornai's 90th birthday - is to bring together scholars from a wide variety of disciplines (economists, political economists, political scientists, sociologists and historians), advanced scholars as well as PhD students who build on Kornai’s insights (www.kornai-janos.hu) in their own research."..."Important dates:Deadline for abstract submission: September 15, 2017Notification of acceptance: October 1, 2017Payment of conference fees: February 1, 2018Full paper submission: February 1, 2018Conference: Feb 21, 2018

[G translate: The academic who opted to stay in his Tucumán
He has just turned 80 and the academy will pay a tribute to the Doctor of Economics from the University of Chicago and director of the UNT Magister. His students remember the teachings [of] the teacher who, he confesses, is fed by the creativity of aspiring economists.]

We consider stability concepts for random matchings where agents have preferences over objects and objects have priorities for the agents. When matchings are deterministic, the standard stability concept also captures the fairness property of no (justified) envy. When matchings can be random, there are a number of natural stability / fairness concepts that coincide with stability / no envy whenever matchings are deterministic. We formalize known stability concepts for random matchings for a general setting that allows weak preferences and weak priorities, unacceptability, and an unequal number of agents and objects. We then present a clear taxonomy of the stability concepts and identify logical relations between them.Furthermore, we provide no envy / claims interpretations for some of the stability concepts that are based on a consumption process interpretation of random matchings. Finally, we present a transformation from the most general setting to the most restricted setting, and show how almost all our stability concepts are preserved by that transformation.

"Accredited epilepsy and clinical neurophysiology fellowships in the United States do not participate in a formal matching system to facilitate selection of trainees. For the 2015 to 2016 academic year, there were about 95 accredited clinical neurophysiology fellowship programs offering 313 positions and 43 epilepsy fellowship programs with 106 available positions. Each of these programs has their own unique recruitment process. The lack of a standardized process may be disadvantageous for both applicants and the training programs.

With our current approach, applicants may feel compelled to accept a fellowship offer before completing other program visits and with little time to consider their options. This situation occurs when a position is offered on the spot or soon after an interview. Unless the offer is quickly accepted, the candidate risks losing a guaranteed opportunity in order to explore other programs. The lack of uniformity in the application process can create additional difficulties for applicants.

Similarly, knowing that good candidates are likely to receive offers from other institutions during an interview, many institutions feel compelled to make a quick decision in their selection of fellows. In an effort to avoid vacancies, program directors may be tempted to select applicants who are available but may not be the best choice. Adopting a formal match system would create a more organized process with clear advantages for both applicants and programs."

"Vedic law in Ancient India condemned usury, and rulers routinely capped interest rates from Ancient Mesopotamia to Ancient Greece. In Politics, Aristotle described usury as ‘the birth of money from money’, and claimed it was unnatural because money was sterile and should not ‘breed’.
...
"In the 4th century CE, Christian councils denounced the practice, and by 800, the emperor Charlemagne made the prohibition into law. Accounts of merchants and bankers in the Middle Ages frequently include expressions of anguish over their profits. In his Divine Comedy of the 14th century, the Italian poet Dante Alighieri put the usurers in the seventh circle of Hell..."

"The stigma against moneylending continued well into the 1500s. To understand it, think about your reaction to the idea of a bank making a loan to a business at a 5 per cent interest rate. No problem, right? Now compare that to how you’d feel if your mother lent you money on the same terms. In Biblical times, the typical loan was more like the second case – it wasn’t an arms-length transaction, but a charitable loan from a wealthy man to a neighbour who’d experienced misfortune or had nowhere else to turn. "

Here's an article from the June issue of Health Affairs, reporting that racial disparities among deceased-donor kidney recipients seem to have declined since the introduction of a modified allocation procedure.

2Jason M. Hockenberry is an associate professor in the Department of Health Policy and Management, Rollins School of Public Health, at Emory University.

3Laura Plantinga is an assistant professor in the Department of Medicine, Emory University School of Medicine.

4Mohua Basu is a data analyst at the Emory University School of Medicine.

5Stephan Pastan is an associate professor in the Department of Medicine, Emory University School of Medicine.

6Sumit Mohan is an assistant professor in the Division of Nephrology, Department of Medicine, and in the Department of Epidemiology at Columbia University Medical Center, in New York City.

7David H. Howard is an assistant professor in the Department of Health Policy and Management, Rollins School of Public Health, at Emory University.

8Rachel E. Patzer (rpatzer@emory.edu) is an assistant professor in the Department of Surgery and Department of Medicine at the Emory University School of Medicine, and in the Department of Epidemiology at the Rollins School of Public Health.

Health Aff June 2017 vol. 36no. 6 1078-1085

Abstract

Before the 2014 implementation of a new kidney allocation system by the United Network for Organ Sharing, white patients were more likely than black or Hispanic patients to receive a kidney transplant. To determine the effect of the new allocation system on these disparities, we examined data for 179,071 transplant waiting list events in the period June 2013–September 2016, and we calculated monthly transplantation rates (34,133 patients actually received transplants). Implementation of the new system was associated with a narrowing of the disparities in the average monthly transplantation rates by 0.29 percentage point for blacks compared to whites and by 0.24 percentage point for Hispanics compared to whites, which resulted in both disparities becoming nonsignificant after implementation of the new system.

From the paper:

"The United Network for Organ Sharing implemented a new kidney allocation system in December 2014,26 in part to address long-standing racial/ethnic disparities in the allocation of deceased donor kidneys. The primary factor for determining a patient’s priority level on the waiting list for a kidney transplant is how long he or she has been waiting. Under the new system, the starting point for calculating waiting time was changed from the date the patient was put on the waiting list to the earliest of either that date or the date of the patient’s first regular dialysis. This change was expected to benefit minorities because blacks and Hispanics spend more time on dialysis before being put on the waiting list, compared to white patients.27,28 The new system made additional changes meant to improve access to transplantation, including making it easier for patients with a highly sensitized immune system to receive transplants and increasing the sharing of kidneys across donor service area boundaries. It is important to note that this policy targets the allocation of deceased-donor kidneys, not of live-donor kidneys."

Wednesday, July 19, 2017

Blackmail isn't what I usually mean when I speak of a repugnant transaction, because it isn't a voluntary transaction that third parties wish to prevent, it's a crime that someone assaults someone else with. But, just as some praiseworthy transactions (like donating a kidney to someone who needs a transplant) can become repugnant when money is added (both demanding compensation and compensating the donor of a kidney for transplant is a crime almost everywhere), the crime of blackmail involves combining actions that are otherwise legal but that together are criminal.

For example, if someone knows something about you that you would like to conceal, it is quite often legal for them to reveal it to interested parties, or even in a biography of you they might write (e.g. your past arrests, affairs, political affiliations and contributions, etc.). It would also be quite legal for you to approach someone and commission them to write something about you, including something over which you might have editorial control. But if someone proposes to combine these things, by threatening to write bad things about you unless you pay him money, that is in many cases the criminal act of blackmail.

More on blackmail and it's subtleties (e.g. I can't demand that you pay me if you don't want me to reveal that you are a thief, but I could threaten to report you the police if you don't pay me for something you stole from me...) in this interesting column at the Washington Post's Volokh Conspiracy:Blackmail is surprisingly hard to define

Tuesday, July 18, 2017

One of the problems with intravenous drug addition is that addicts can overdose and die. A number of North American cities are trying to combat this by opening supervised drug injection sites, meant to be safe places to shoot up, staffed with one or more healthcare workers and social workers.

Sunday, July 16, 2017

Here's a post I just looked at from The National Center for the Study of Privatization in Education at Teachers College at Columbia (posted in April). It is about more and less illuminating ways to discuss how popular New York City high schools are, as reflected in how often they are on students' rank order lists, how many students they make offers to, and how many seats they have.

Produced by the journalist Iván Carrillo, it tells the story of Marisol Robles, publisher and poet from Veracruz, who was diagnosed with kidney failure on June 28th, 2011 and who, after a failed first attempt of kidney transplant, recorded the vicissitudes of her illness in her blog: The Thirst Journal.

The documentary talks about how the encounter and collaboration with Mike Rees, MD, from Toledo University Medical Center (Ohio) and the professor in economy of Stanford University Alvin Roth, will result in a series of innovations in the field of medicine through economy, revolutionizing the form kidneys are exchanged in the world. This innovation will become an important part of the merits mentioned on 2012 for Alvin Roth to receive the Nobel Memorial Prize in Economic Sciences.

OPPENING HOURS AND ADMISSION:

July 14 2017
Friday , 10:00 - 12:00 hrs.
Free admission

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Here's another announcement: the film will celebrate the Museum's 11th anniversary

The Interactive Museum of Economics (MIDE) emerged as an initiative of the Bank of Mexico to be a space for the dissemination of economics and finance.

It is the first museum in the world dedicated to explaining economics, finance and sustainable development with the most advanced technologies, offering visitors fun and relevant experiences in an environment that stimulates emotions and learning.